Jun 7, 2012 7:46 AM

Hello and thank you in advance for any advice. This injury really has me down and I’m not sure the most efficient way to “fix” it.

I have a dull pain in my left big toe. I’ve had it now for about five months. Currently, when I walk, I can feel it every so slightly slip back into place when I put my foot down. There is no pain from this “slip” and it’s really, really slight but I focus on my toe so much now I can notice it. It also feels a bit like the webbed part of my foot, between my big toe and the next toe is slightly swollen unless I wear shoes with a wide toe box.

I can run about 4 miles with minimal pain or discomfort although I do notice the dull pain in my toe joint. I could possibly run more but haven’t been pushing it since I don’t want the toe to heal if possible.

I am 34 and always been healthy and active. I have run quite a few races from short to ultra with no toe issues in the past. I stretch a decent amount for a runner but have neglected this in the past.

Many things come to mind when I consider what could have caused this. Ski boots too tight causing my toe to bang? Moving to a more minimal shoe? Running more on concrete (recently moved to downtown Atlanta). Increasing mileage too fast?

I first went to an orthopedic doctor. He diagnosed me with chronic turf toe as he could pop my toe up and out of the joint. He said that it won’t heal and to buy stiff inserts for all of my shoes to limit the toe bending too much when I walk. He did some X-Rays and said there was nothing of additional concern (bone spurs, etc.). Of course, I was not pleased to hear this since it would severely limit my ability to run. I did my best to convey how important running is to me but I didn’t receive much sympathy. He also told me to take a high dose of anti-inflamitories and limit time on my feet with no running for two weeks which I did.

I went to a podiatrist (Dr Peebles). He works under Dr Perry Julien who I have read is very well known in the area. Dr Peebles is a runner so I felt he would understand the urgency and concern I have around my toe. I was pleased with my visit. He reviewed my X-Ray and confirmed there were no bone issues. He then said that the orthopedic doctor was incorrect in his assessment. Dr Peebles gave me some dancers pads to allow the big toe room by elevating the area just before and around the big toe joint. I wore those for 3 weeks and ran in them a bit at the guidance of the doctor.

My toe began to feel better. I went in for another visit and the doctor said I could start slowly running on it without the pads. He said that I had a mild case of Hallux Limitus but said he expects a full recovery (wasn’t aware that was possible). He said if things got worse he could give me a shot of cortisone (that’s a temporary fix) or build me orthotics.

I built mileage with the most patience I have ever in the past. One mile at a time once or twice a week for a few weeks. I’m now at 12 miles or so a week and while I could maintain that without causing additional injury I still have pain – even if I were to walk quite a bit in a day (if traveling and sight seeing).

I also visited my trusty shoe store to get a more stable shoe that had less side to side flex (at the advice of my podiatrist). They advised me that the shoes I have were the best for me even as I was trying to buy another pair. I run in the PureFlow and the footprint is fairly wide throughout the entire shoe.

So I’m stuck with where to focus. Go back to the orthopedic doctor, the podiatrist or go to another running store to see if a different pair of shoes might help.

Thank you for reading through this and I sincerely appreciate any recommendations if others have had similar experiences.

Turf Toe and Hallux Limitus are very close relatives. Turf Toe Injury will progress to Hallux Limitus. My recommendcation for Turf Toe and Hallux Limitus is selecting shoes with a stiff forefoot, wide roomey toe box, and a rockered type sole. Place the shoe on a firm surface and press the tip of the shoe the shoe that rocks very easy is a shoe which has more of a rockered sole. Skip the first eyelet of the shoe to allow for more room around the big toe joint. The foot print test is not very helpful when it comes to selecting shoes. Take a look at this short article Crediability of Shoe Selection Based on Foot Print Shape and Risk of Injury. Avoid postures and position of the foot which stretch the plantar fascia. Take a look at Foot Posture Foot Pain Every Day Position.

The title of this post caught my interest. I do not have the same problem, but it reminded me of mine. I hope you dont mind my piggy-backing on this thread.

I broke my right big toe 6 days ago. Sat night, I pulled a large pot out of a cabinet, and dropped it on my bare foot. Lots of pain! I iced and elevated right away. Sunday afternoon I went to the minor emergency center (big toe swollen, lots of purple and blue all around the toe and into my foot). They took an xray and said it had a break in 2 places, one at a joint. They referred me to an orthopedic surgeon, and gave me a stiff shoe and crutches. I saw the surgeon Tuesday, and he said he thought the breaks would heal OK without his intervention (whew!). I see him again in 3 weeks to take new xrays and see how things are going. He told me to stop walking on my heel, that would cause other problems, and the stiff shoe would protect my toe. He said I didnt need to use the crutches.

So...I'm trying to keep the foot elevated as much as possible, walking as little as possible, but walking as he suggested, a flat-footed clomp. There is not much pain at all, which I'm hoping is a good sign. At this point it is still swollen and colorful.

My concern is what this might mean for running after it heals. I've read that the big toe is important, and a fracture can cause problems running even after it's healed.

Thank you Damien. So it sounds like there is no holistic way for the toe to heal - it will just progressively get worse or just stay the same if I buy better shoes and keep the mileage low? That would be extremely sad news.

So it sounds like I should go invest in some new shoes for the short term (that follow your guidance above) and set up another appointment with my ortho to see if he has any other ideas? I have read there are surgeries that can be done and not sure if he would guide me that way or just try to make me a custom footbed to lessen the pain.

Any insight is greatly appreciated as I have yet to find a path that will heal or fix my toe and get me back to distance running.

Toes are not as important to running as people may think, since they do not absorb impact or provide the major propulsion in running. They are more for guidance and finesse, and a well-healed toe, so to speak, should cause little trouble when you run. Think of the leg-less athletes who use prosthetic "Cheetahs," which have nothing even faintly resembling toes, yet can power runners using them to near-Olympic performance.

The stiffer shoes recommended by Damien may help to de-emphasize involvement of the individual toes.

Certain running styles, ie: excess pronation, may depend more heavily on the big toe for guidance at the end of the footstrike. If this is the case with you, it is worth a separate discussion. See if you can have your gait analyzed for this common trait.

The big problem now is more about pain-management, which is a dangerous area, as I will soon discuss. Barring any complications or related pathologies, and depending somewhat on your age, you should experience less pain in the healed bone(s) of your toe as the years pass. Just have the patience to weather your current discomfort, in the spirit of a true athlete. At least you don't have to run in Cheetahs!

Scott, applying a bit of common sense to what you learned so far, if the "dancers pads" appeared to help for 3 weeks, there may be a reason for that. Pads that elevate the 1st metatarsal head, just before the big toe, have been shown to limit rolling onto the big toe in pronation for many people - not by restricting the movement, but by making it unnecessary for stability. Perhaps there is a connection between this strategy and your original condition, as well as the relief you found when wearing them. I use similar pads in both shoes all the time. It tends to help those with a particular bone structure in their foot.

I'm glad your podiatrist called the Ortho on his hasty diagnosis/prognosis/prescription, or whatever else he tactfully referred to as "incorrect." Wide use of anti-inflammatories is becoming an embarrassment for the medical profession in general, because of the nasty side effects and limitations to healing attending their use, all in the name of pain-control. However, the healthcare-buying public is partly to blame for this continuing trend, because we are so pain-averse we will go out and buy them over the counter ourselves if not prescribed. Doctors feel pressured to provide the quick pain-fix to perpetuate their reputation as miracle workers. We expect nothing less, even when it is not in our own self-interest, and the doc's image of wizardry is protected.

Another error for which the Ortho shall remain unforgiven is confusing an anatomical trait with something that can't "heal," replacing the hope you sought with hopelessness. Of course it won't heal. It's as much a part of you as your eye color. What you needed was guidance toward a way to optimize your anatomical type for running, which it took a real, involved, interested running physician to do. However, he was careful to remain technically correct and within the "standard of practice," above reproach or risk of malpractice. He told you a discouraging version of the truth and knocked out your pain, telling you not to run, which makes the problem appear to go away. Such is the state of medicine today.

Once again, if you can de-emphasize your reliance on the big toe for stability, you will be able to indulge in your passion for running more. While this is not always an area of expertise for podiatrists, the information is out there. If you haven't already, have your gait analyzed for excess pronation that loads the big toe, and see if the pads help in this regard. The fix is not always instantaneous, but the running muscles can be re-educated in a reasonable amount of time. Reduction of pain and overuse injuries should follow.